A Sydney paramedic fell to his death while attempting a dangerous rescue manoeuvre that neither he nor his team had been trained to use, the Coroners Court has heard.

Michael Wilson, a member of the state's Special Casualty Access Team (SCAT), died on Christmas Eve in 2011 at Bridal Veil Falls, 16 kilometres south-west of Wollongong.

An inquest into the 42-year-old's death heard on Monday that Mr Wilson and his team flew to the falls in the early evening after a canyoner, Matthew Shewchuck, was injured in a fall and activated his rescue beacon.

After discovering that a conventional winching operation was impossible given Mr Shewchuck's location, Mr Wilson suggested that he and his team "do a Kerno".

This was a reference to a daring "hi-line" rescue carried out months earlier by fellow SCAT paramedic Paul Kernick, who winched an injured BASE jumper into a helicopter even though the helicopter could not hover directly overhead.

Neither Mr Wilson nor his team had been trained to undertake this manoeuvre in such conditions.

"When he suggested the 'Kerno', I said no," Mr Wilson's colleague on the rescue, Tim Thistleton, told the NSW Coroners Court.

"I think after seeing the video [of the Kernick rescue] with all the issues … I just thought that was potentially dangerous … I didn't want to.

"He told me that I didn't understand … He proposed that we get the hook to the patient from the top of the falls to the ledge via the tag line.

"I'm really trying to think hard about what changed my mind. I just thought it was a safer, more efficient way of getting the hook to the accident site."

The court heard that, after abseiling down to the ledge where Mr Shewchuck was lying and hooking himself and the canyoner up to the winch, the pair fell or were pulled off the edge.

"We hit the second ledge and then we were free-falling," Mr Shewchuck told the hearing.

The pair ended up in a pool at the bottom of the falls.

Mr Shewchuck was able to cut himself free but, suffering from a fractured vertebrae, could not pull his rescuer to safety.

Mr Wilson died from internal haemorrhaging.

The inquest will examine whether the pair were pulled off the ledge by the winch cable, whether Mr Wilson slipped or whether an attempt to abseil off the ledge failed.

"Short of all the evidence, the plan devised was one which your honour might conclude should never have been put into effect," counsel assisting the inquiry Mark Cahill said.

"It is difficult to understand how the plan could have passed muster with others."

In a written statement, Mr Wilson's wife, Kellie, said he had "died a hero, doing what he loved, saving lives and helping those most in need".

"This is a difficult and emotional time for our family," she said. "Myself, our three beautiful children, Michael's parents and siblings, colleagues and friends still miss him every day.

"We welcome the opportunity that this inquest represents to give further insight into what happened … and to make NSW Ambulance a safer workplace."